Term
| name some thiazide diuretics |
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Definition
chlorothiazide (IV)
chlorthalidone
hydrochlorothiazide
indapamide
mehyclothiazide
metolazone |
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Term
| mechanism of action of thiazide diuretics |
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Definition
| inhibit reabsorption of Na+ and Cl- ions in the cortical portion of the loop, the loo of Henle, proximal and distal renal tubules |
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Term
| effect of thiazide diuretics on electrolytes |
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Definition
| marked increase in urinary excretion of Na, Cl, bicarb, and K+ |
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Term
| Antihypertensive effects of thiazide diuretics |
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Definition
| initially decrease due to less fluid volume->lower CO, but sustained decrease in BP r/t peripheral vasodilation |
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Term
| adverse efects of thiazide diuretics |
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Definition
hypokalemia, hypochloremia, metabolic alkalosis, depletion of Na and Mg
hypovolemia-(increase in Hct and BUN)
hyperglycemia-agrevate DM
increase uric acid and aggravate gout |
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Term
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Definition
| cardiac arrhythmias, skeletal muscle weakness, ileus, nephropathy, increase digoxin toxicity, potentiate NMB agents |
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Term
| Loop diuretics-mechanism of action |
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Definition
inhibit reabsorption of Na and Cl in the medullary portion of the ascending limb of the koop of Henle
peripheral vasodilator-decreases preload |
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Term
| difference in responses of loop and thiazide diuretics r/t GFR |
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Definition
| loops responses occur over large range of GFR whereas thiazides are ineffective if GFR <20-30ml/ minute |
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Term
|
Definition
bumetanide
ethacrynic acid
furosemide
torsemide |
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Term
| uses for thiazide diuretics |
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Definition
given orally for the initial tx of essential hypertension
+works well with other agents
+treats diabetes insipidus-helps kidneys to regognize ADH
+treat hepercalcemia
+Iv formulation (Chlorothiazide) use to help mobilize edema fluid r/t renal, hepatic, and cardiac dysfunction |
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Term
| which loop diuretic is not a sulfonamide? |
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Definition
| ethacrynic acid-use for sulfa allergy |
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Term
|
Definition
edema r/t renal, hepatic,or cardiac dx
tx increased ICP, pulmonary edema
differential diagnosis of acute oliguria
+++have little use for chronic HTN |
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Term
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Definition
| systemic diureses decreases CSF production. Can be used with Mannitol, but severe dehydration and electrolyte imbalance may occur |
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Term
| loop diuretics and dx of acute oliguria and ARF |
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Definition
will stimulate diuresis with SIADH
+urine output may mask volume depletion
+use with ARF is controversial |
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Term
| adverse reactions with loop diuretics |
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Definition
Hypokalemia, dig toxicity, hypochloremia->alkalosis, enance NMB, hyperglycemia, hyperurecemia, increases nephrotoxic effects of cephalosporins and aminoglycosides (gent, tobra, amycacin, streptomycin)
allergic interstitial nephritis, lithium toxicity, damage to cranial nerve VIII->deafness |
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Term
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Definition
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Term
| osmotic diuretics-how do they work? |
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Definition
| increases plasma osmolarity and draws water from ICS to ECS and redistributes fluid to help decrease brain bulk and may increase renal blood flow. |
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Term
| clinical uses of osmotic diuretics? |
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Definition
prophylaxix against ARF.
differential dx of acute oliguria.
treat increased ICP
decrease intraocular pressure->closed angle glaucoma |
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Term
| What is necessary for Mannitol to work on ICP? |
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Definition
| intact blood/brain barrier |
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Term
| what diuretic will increase urine output even when there is a decrease in intravascular volume? |
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Definition
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Term
| adverse reactions with Mannitol |
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Definition
pulmonary edema in CHF pts.
hypovolemia, electrolyte disorders, plasma hyperosmolarity, renal ischemia may make tubules impermeable to mannitol |
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Term
| why isn't urea used often? |
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Definition
can cross the BBB and cause rebound increase in ICP.
high incidence of venous thrombosis
tissue necrosis with extravasation |
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Term
| K+ sparing diuretics-names |
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Definition
| amiloride and triamterene |
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Term
| clinical uses of K+ sparing diuretics? |
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Definition
| esssential HTN.+++ used with a thiazide diuretic it increases the efficacy of both drugs while offsettng their effects on potassium excretion |
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Term
| spiranolactone-what is it? |
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Definition
aldosterone antagonist that is a synthrtic steroid. It blocks the renal effects of aldosterone and leads to Na and water excretion.
also acts as an antiandgrogen causing gynoclamastia |
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Term
| What is spiranolactone used for? |
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Definition
tx of ascites r/t cirrhosis
decreases mortality of CHF
anti-HTN effects like thiazides |
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Term
|
Definition
selective antialdosterone antagonist.
does not have andronergic effects like spiranolactone.
can cause hyperkalemia, severe arrhythmias, MI and angina |
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Term
| carbonic anhydrase inhibitors |
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Definition
acetazolamide-sulfonamide binds to carbonic anhydrase to form noncompetative inhibitioon of this enzyme in the proximal tubule.
Excretion of Na, K+ and bicarb is increased. |
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Term
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Definition
decrease intraoccular pressure by decreasing production of aqeous humor.
decreases CSF production.
decreases seizure activity by indusing metabolic acidosis.
used to Tx metabolic alkalosis. |
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